Trends in depressive symptoms among high school students with and without health-risk behaviors in the United States: A population-based study.

Background: Despite the recent rise in depressive symptoms among adolescents, trends in at-risk groups remain poorly understood. This study estimated national trends in depressive symptoms among high school students with and without health-risk behaviors.

Methods: Data were analyzed from the 2007 to 2021 Youth Risk Behavior Survey (YRBS), a biennial cross-sectional survey of US high school students (n = 119,654). Depressive symptoms were defined as past-year feelings of sadness/hopelessness almost every day for ≥2 weeks impacting usual activities. 24 health-risk behaviors across five categories (violence, substance use, sexual, physical/sedentary, and weight-related) were considered. Multivariable-adjusted logistic regression identified health-risk behaviors independently associated with depressive symptoms. National trends in depressive symptoms among students with and without these health-risk behaviors were estimated. National trends in health-risk behaviors were also estimated among those with depressive symptoms.

Findings: Among 119,654 students (mean age, 16.0 [SD = 1.2] years; 50.1% females; and 45.3% non-Hispanic White), depressive symptoms increased from 28.4% (2007) to 42.3% (2021) (biennial average percent change (BAPC), 3.0% [95% confidence interval (CI), 2.6-3.4%]). The largest increases occurred among females (BAPC, 3.3% [2.9-3.8%]) and non-Hispanic White students (BAPC, 3.6% [3.0-4.1%]). Depressive symptoms increased more among students engaging in ≤1 risk category (BAPC = 4.6% [3.6-5.7%]) than students engaging in 4-5 risk categories (BAPC = 2.9% [2.4-3.3%]) (interaction,  = 0.037) and there was a general trend toward decreasing engagement in risk behaviors among students with depressive symptoms. In subgroup analyses, there was a disproportionately large increase in depressive symptoms among students reporting cannabis use, high-risk screen time, shorter sleep hours, and unhealthy weight perception.

Interpretation: Depressive symptoms increased faster among high school students without than with multiple behavioral risk factors. A broadening of the depression risk profile underscores the potential value of universal depression screening to identify students who may otherwise go undetected by targeted screening.

Funding: The study was not funded.